{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T17:01:52Z","timestamp":1784566912433,"version":"3.55.0"},"reference-count":88,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T00:00:00Z","timestamp":1718150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The current high standards in orthognathic surgery demand surgical solutions that are both \u2060 functionally \u2060 effective and aesthetically pleasing. Our approach offers one for enhanced stability, attractiveness, and nerve protection \u2060 with improved accessibility \u2060 in the majority of orthognathic scenarios \u2060 compared to an inverted L osteotomy. Methods: A case series is presented to illustrate the application and outcomes of HSSO, an optimised approach that combines the advantages of a transoral inverted L osteotomy with specific enhancements and increased versatility, \u2060 with accessibility and exposure similar to a BSSO. Results: HSSO as a completely transoral technique, demonstrate the ability to perform significant counterclockwise rotations of the mandible, eliminating the need for trocars or skin incisions. We experinced high postoperative stability when HSSO was performed in conjunction with a three-piece LeFort 1 osteotomy on a dynamic opposing arch. In comparison to an inverted L approach, we postulated that HSSO offers advantages in stability, due to the increased segmental overlap of the proximal and distal segments of the mandible. This approach is designed to enhance the safety of the inferior alveolar nerve compared to traditional sagittal split methods. Furthermore, HSSO represents an alternative to total joint replacement in select cases of idiopathic condylar resorption and is effective for correcting mandibular asymmetries while maintaining jawline aesthetics. This is achieved through the manipulation of the mandibular angle, ramus height, and inferior border without creating a step deformity in the soft tissue. Conclusions: The outcomes of HSSO highlight its capacity to deliver predictable, functional, and aesthetically pleasing results, offering a viable alternative to more traditional orthognathic techniques.<\/jats:p>","DOI":"10.3390\/jcm13123438","type":"journal-article","created":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T06:23:11Z","timestamp":1718259791000},"page":"3438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Hanna\u2019s Modified Sagittal Split Osteotomy (HSSO): An Alternative to Inverted L Osteotomy\u2014Merging Function and Aesthetics for Enhanced Stability, Attractiveness, and Nerve Protection"],"prefix":"10.3390","volume":"13","author":[{"given":"Todd","family":"Hanna","sequence":"first","affiliation":[{"name":"Private Practice, Hanna Face and Jaw PC, New York, NY 10029, USA"},{"name":"Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketan","family":"Bansal","sequence":"additional","affiliation":[{"name":"Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA"},{"name":"Department of Oral and Maxillofacial Surgery, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4964-2285","authenticated-orcid":false,"given":"Robert Radu","family":"Ilesan","sequence":"additional","affiliation":[{"name":"Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA"},{"name":"Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Harmoniestraat 48, 2018 Antwerp, Belgium"},{"name":"Department of Cranio-Maxillofacial Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium"},{"name":"Faculty of Medicine & Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Buchbinder","sequence":"additional","affiliation":[{"name":"Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Posnick, J.C. 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